Provider Demographics
NPI:1659882777
Name:TRUSE, KATHLEEN JOAN (MS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JOAN
Last Name:TRUSE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16945 SAYRE AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2727
Mailing Address - Country:US
Mailing Address - Phone:708-712-8681
Mailing Address - Fax:
Practice Address - Street 1:514 MACGREGOR RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-2759
Practice Address - Country:US
Practice Address - Phone:815-838-7858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009825235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist